From the Guidelines
Elevation in creatine kinase (CK) is primarily caused by damage to tissues containing this enzyme, particularly muscles, heart, and brain, with common causes including strenuous exercise, muscle trauma, muscle diseases, heart attacks, and certain medications such as statins, as reported in a study published in the Journal of the American College of Cardiology 1. The most common causes of CK elevation include:
- Strenuous exercise
- Muscle trauma
- Muscle diseases like muscular dystrophy and myositis
- Heart attacks
- Certain medications such as statins, colchicine, and some antipsychotics Other causes of CK elevation include:
- Seizures
- Surgery
- Intramuscular injections
- Alcoholism
- Hypothyroidism
- Certain infections The degree of CK elevation can help determine the cause, with mild elevations (2-5 times normal) often occurring with exercise or statin use, and severe elevations (>10 times normal) suggesting serious muscle damage from conditions like rhabdomyolysis, as noted in a study published in Circulation 1. When CK is elevated, identifying the specific isoenzyme (CK-MM from skeletal muscle, CK-MB from heart, or CK-BB from brain) can help pinpoint the source of damage, as discussed in a study published in the Journal of the American College of Radiology 1. Treatment depends on addressing the underlying cause, which may include:
- Stopping offending medications
- Treating infections
- Managing autoimmune conditions
- Providing supportive care for rhabdomyolysis with intravenous fluids to prevent kidney damage, as recommended in a study published in Clinical Gastroenterology and Hepatology 1.
From the Research
Causes of Elevation in Creatine Kinase
- Elevation in creatine kinase (CK) can be caused by various factors, including myocardial infarction 2, statin-associated myalgias and muscle injury 3, 4, and exertional rhabdomyolysis 5.
- Myocardial infarction can lead to an increase in CK levels, particularly the CK-MB isoenzyme, which is a sensitive marker for myocardial damage 2.
- Statin use can cause muscle complaints, including myalgias and elevated CK levels, with some patients experiencing statin-associated autoimmune myopathy 3, 4.
- Exertional rhabdomyolysis, a condition characterized by muscle breakdown and elevated CK levels, can be triggered by excessive muscular exertion, such as strength training or endurance exercises 5.
- Other factors, such as trauma, can also contribute to elevated CK levels, with trauma being the most common cause of rhabdomyolysis 5.
Factors Influencing CK Elevation
- Preinfarctional beta-blockade may result in lower CK-MB levels in patients with myocardial infarction 2.
- The extent of coronary disease can influence CK-MB levels, with patients having three-vessel disease tend to have higher peak CK-MB levels than those with one- or two-vessel disease 2.
- Age, body frame, and other systemic diseases, such as hepatic or renal diseases, diabetes mellitus, or hypothyroidism, can increase the risk of statin myopathy and elevated CK levels 4.
- Exercise intensity and duration can also impact CK levels, with high-intensity exercise leading to higher lactate and ammonia levels, and increased ventilatory responses in individuals with elevated CK levels 6.